I would like to know more about Micropulse Laser Trabeculoplasty (MLT) for lowering intraocular pressure in glaucoma. How effective is it compared to SLT and to other laster treatment options?
Micropulse Laser Trabeculoplasty (MLT) is another laser trabeculoplasty option for glaucoma in addition to ALT and SLT. It targets the trabecular meshwork, like the other two, but as its name implies, it uses a pulsed energy laser. MLT success rates after one year are comparable to SLT according to one study (summarized below).
(Another laser surgery option for glaucoma is Micropulse transscleral cyclophotocoagulation.)
MLT treatment is applied across the entire 360º of trabecular meshwork with a target of 120 treatment spots.
The manufacturer makes the following claims:
There are a number of studies on MLT. Here are a couple:
2018 Dec 19; 7:156. doi: 10.4103/abr.abr_203_17. eCollection 2018.
Background: We report the effect of micropulse laser trabeculoplasty (MLT) in the intraocular pressure (IOP) of patients with uncontrolled open-angle glaucoma (OAG).
Materials and methods: In this retrospective review, 30 eyes with OAG were treated with a single session of MLT at the Vista Clinic in Lima Perú. We used a 532 nm frequency doubled Nd: YAG laser to 360° of the trabecular meshwork with a power of 1000 mW, 15% of the duty cycle, and 300 ms of exposure. The IOP was measured at baseline and at 1 day, 1 week, 3 months, and 6 months post-treatment and were followed up for one last control.
Results: The mean baseline IOP was 15.6 mmHg and in the last control was 12.8 mmHg, mean follow-up time of 19 months (±10 standard deviation [SD]). The mean reduction of IOP in the 1st day was 1.6 mmHg (±2.6 SD) and 1.2 mmHg (±3.3 SD) in the last follow-up. The mean percentage of IOP reduction was 17.9% and 7 eyes (40%) had IOP reduction >20%. No statistical significant difference in relation to demographic characteristics of the patients. The greatest reduction was achieved in the 1st day with a median of 2.00 (P < 0.001). A tendency to achieve a higher reduction of IOP in patients with higher baseline IOP was found but was not statistically significant. No adverse reactions occurred.
Conclusions: MLT slightly reduced the IOP in a few patients with uncontrolled OAG for a very short time and may not be suitable for these patients.
2021 Jan 22; 15:243-251. DOI: 10.2147/OPTH.S285136
Background: There is limited long-term data comparing selective laser trabeculoplasty (SLT) to the newer micropulse laser trabeculoplasty (MLT) using a laser emitting at 532 nm. In this study, we determine the effectiveness and safety of MLT compared to SLT.
Design: Retrospective comparative cohort study.
Participants: A total of 85 consecutive eyes received SLT and 43 consecutive eyes received MLT.
Methods: Patients with open-angle glaucoma receiving their first treatment of laser trabeculoplasty were included. Exclusion criteria are prior laser trabeculoplasty, laser cyclophotocoagulation or glaucoma surgery, and follow-up of less than 1 year.
Main outcome measures: The primary outcome was success at 1 year, defined as a reduction in intraocular eye pressure (IOP) by ≥20% from baseline or met prespecified target IOP with no additional glaucoma medication or subsequent glaucoma intervention.
Results: Baseline IOP was 18.0 mmHg (95% CI=16.4-19.5) in the MLT group on an average of 1.8 (95% CI=1.4-2.2) glaucoma medications compared to 18.2 mmHg (95% CI=17.2-19.3) for the SLT group on an average of 2.0 (95% CI=1.6-2.3) medications. At 1-hour post-laser, the SLT group had more transient IOP spikes (MLT 5% vs SLT 16%, P=0.10). There was a trend toward increased success in the SLT group compared to MLT at 1 year (relative risk=1.4, 95% CI=0.8-2.5, P=0.30).
Conclusion and relevance: Eyes had similar success after MLT compared to SLT at 1 year. Laser trabeculoplasty with either method could be offered as treatment with consideration of MLT in those eyes where IOP spikes should be avoided.
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